High Blood Pressure May Protect Some Frail Elderly: Study

MONDAY, July 16 (HealthDay News) — Frail, elderly people with
high blood pressure may live longer than their peers with lower blood
pressure, new research suggests.

In the study of 2,340 seniors, low blood pressure protected those who
were healthier and more robust, but the same could not be said for their
frail counterparts. In general, high blood pressure, or hypertension, is a
major risk factor for heart attack and stroke.

Researchers used data from two yearly U.S. National Health and
Nutrition Examination Surveys. The new findings were published online July
16 in the Archives of Internal Medicine.

Frailty and fragility was assessed via walking-speed tests. Study
participants were asked to walk for about 20 feet at their normal pace.
Those who walked less than 2.6 feet per second were “slower walkers.”
Their faster-walking counterparts had lower rates of diabetes, heart
disease and other health problems. A third group included participants
who were unable to complete the walking test.

In this third group, those frail seniors with higher blood pressure
levels were 62 percent less likely to die during the study period when
compared to their counterparts with lower blood pressure levels.

“Older frail adults might benefit from slightly higher blood pressure,”
said study author Michelle Odden, a public health epidemiologist at Oregon
State University, in Corvallis, Ore. “As the blood vessels get more stiff
with age, it may be necessary to have more pressure to keep blood pumping
to the central organs, like the brain and heart.”

It’s too early to make any treatment recommendations, Odden said. “Our
study does support lower blood pressure in healthy elderly people,” she
said.

Each patient is different, she noted. “If you have seen one older
adult, you have seen one older adult,” she said. “This really sums up the
wide variety of health status we see in older adults.”

The study linked data from the nationwide health surveys in 1999-2000
and 2001-2002 to U.S. National Death Index data through December 2006.
During the study, 589 people died. Faster walkers with high blood
pressure were 35 percent more likely to die, compared to those fast
walkers with normal blood pressure levels, the study showed. There was no
link seen between high blood pressure and death among slow walkers.

According to the American Heart Association, normal blood pressure is
a systolic pressure of less than 120 and a diastolic pressure of less than
80. Systolic pressure (the upper number in a blood pressure reading)
refers to pressure in the arteries when the heart beats. Diastolic
pressure (the lower number) measures pressure in the arteries between
heart beats.

One expert said the new results would have a direct impact on clinical
practice.

Among older people with chronic conditions “hypertension is amongst the
most common, and choosing one, two or three drugs to reduce blood pressure
is an all-too-common dilemma,” said Dr. Bradley Flansbaum, director of
Hospital Medicine at Lenox Hill Hospital in New York City. “These pills
all have costs and side effects,” he said. “Now, by walking our patients
and determining those folks that can exceed 2 mph or greater — 30 minutes
per mile — doctors can select who will benefit from these classes of
drugs.”

He added that blood pressure treatments that could help a relatively
healthy 80-year-old might not benefit a frailer patient. “Those who cannot
achieve a similar [walking] speed signal a burden of illness and
debilitation that does not warrant therapy, which if used, might even be
harmful.”

Another expert agreed.

When it comes to blood pressure, “‘one size fits all’ doesn’t really
hold,” said Dr. Howard Weintraub, clinical director of the Center for the
Prevention of Cardiovascular Disease at NYU Langone Medical Center in New
York City. “For elderly, frail individuals, our primary focus should not
necessarily be getting their blood pressure down.”

Some of the medications used to treat high blood pressure, including
diuretics and beta blockers, may confer more risk than benefit in this
group, he said.

“We need to focus on hypertension, but give a little slack,” he said,
adding that not every patient will benefit from efforts to lower their
blood pressure. However, he said, “If the systolic pressure is 180, I am
not leaving it alone. I would also treat someone who also has diabetes and
has high cholesterol or other risk factors.” A systolic blood pressure of
higher than 180 is considered a hypertensive crisis, according to the
American Heart Association.

More information

Learn more about high blood pressure (hypertension) at the American Heart
Association.

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